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Home My WebLink AboutCAVALUZZI, DONALDBoa.rd... Of $outhold Town Trustees SO.UTHOLD, NEW YORK PERMIT NO..Emer§en~csr...Storm Damage DATE: .../~t. 9/9.5 ............. ISSUE.D TO ..D.O NALD,.,.GA¥..AL.UZZI .............................................................. Aulhari.zation Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1.893; and Chapter 404 of the Laws of +he State of New York 1'952; and the. South°id Town" Ordinance en- titled "REGULATING 'AND THE. PLACIN'~ OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF-SAND, CoRAVEL: OR OTHER MATERIALS I:ROM LANDS UNDER TOWN WATERS:" and in accordance with 'the Resolution of The Board adopted at a meeting held on .1_/.9./.95 ....... :... 19..95..., and in consideration of the sum of $ ...... paid by of .... : ................................................................................ N. Y.. and subject to the Terms and Conditions listed on +he reverse side hereof, of Southofd Town Trustees' authorizes and permits the following: Emergency Storm Damage Permit to build ]Sulkhead as per DEC specifications and conditions. all in accordance with the detailed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents to be subscribed by a maio. rity of the said Board as of this date. Trustees Bo'ard Of $outhold Town Trustees SOUTHOLD, NEW YORK PurSuant to the provisions of 'Chapter 615 of the Laws of the State of' New York, 1893: and. Chapter 404.of +he Laws of the State of New York 1952; and.the Sou:~hotd Town 'Ordinance en- tiffed '"REGULATINC= AND TIlE PLACING OF OBSTRUCTIONS IN AND .:ON TOWN WATERS. AND' PUBLIC 'LANDS and the REMOVAL OF SAND,' C=RAVEL OR OTHER MATERIALS FROM. LANDS UNDER TOWN WATERS:" and in accordance with the Resolution of The Board adopted at a meeting held on 19 ............. and in consideration of the sum of $.......~.~:k~-:l)~ paid by of ................................................................................... N. Y. and subject fo fha Terms and Conditions listed on the' reverse side hereof, of Sou+hold Town Trustees authorizes and permits the following: all in accordance.with the detailed specifications as presented in the originating application. IN WITNESS' WHEREOF, The sald Board of Trustees here- by causes its Corporate Seal +o be affixed., and these presents to be subscribed by a majority of the said Board as o.f .this date. · TRUSTEES Jotm M. Brede'm.ey~r, tlL ~esident Albert J:'Kmpski, Jr.,. Vice President Henry P. ·Smith John B. 'Tuthill William G: Albertson Telephone. (5.16). 7654892 Fax:(5l~6) 765-1823 'BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SUPERVISOR ?" "' ' SC0TT. L:'.VaU mS Town Hall 53095 ..Main Road · .EO..:'Box t:179 SouthOt~"New.¥6rk'.l1971 COASTAL' EROSION. MANAGEMENT PERMIT permit Number: L4t~ - % - 1~5 Name of APplicant/Agent: Name of Permittee: -~~ ~(.o.~/~\uq~%~ Address of Permittee: ~7~- ~+ q~ ~~ Property Located: ~~ DESCRIPTI ON .OF .ACTIVI~: Date .of permit issuance: D~x:~22, i~52 ~o~-[ I~) lqqD ~'i.s permit is ~alid for a period of two years from the date of i s suanc e. SPECIAL CONDITIONS: luff restoration through a re-vegetation agr'eement is attached hereto and is a necessary special condition of this permit. A relocation agreement is.attached hereto and is a necessary special condition of this permit. ~/ A maintenance .agreement is attached hereto and is a necessary special condition of this Permit.. TRUSTEES John M. Bredemeyer, HI, President 'Henry P. Smith, Vice President Albert J. Krupski, Jr. John L. Bednoski, Ir. John B. Tuthill Telephone (516) 765-1'892 Fax (5.16) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SUPERVISOR SCOTT L. HARRIS Town Hall 53095 Main Road P.O. Box 1179 Southold, NeW York 11971 COASTAL EROSION MANAGEMENT PERMIT APPLICATION TOWN WETLANDS PERMIT'APPLICATION TRUSTEE LANDS PERMIT APPLICATION Office Use Only: Coastal ~Wetland Permit Application Erosion Permit Application Trustee Lands Permit Application Grandfather ~ComP]_eted Apps. Date: ;~"~-~ Variance Required, Neighbors notified Date: SEQRA Type. .Coord. Review-opt. ,mend. ~te Rec. by~_c_e~_ ~InsP:. comp./date:/~-~-~:y Findings: Permit Vote: GN): ~'-%¢'¢~' - SPecial Conditions: (also see file) Application Fee: Application Number; SC2~4 ~.1000- Project Name (If any') Date Prepared: /~/~//.~_~ AppliCant: ~~ Phone ~g .j' 7~'~'g', ' Owner of Property: Address ~ - · Phone ( ) Subject Property Location: (Provide LILCO Pole ~, Distance to cross Streecs if not on location map) THIS IS NOT A PERMIT Yds. to be excavated: ~' -- Yds. to be filled: /~0 Manner in which material will b~ removed or deposited~ Width of .canal, creek or bay fronting property: DePth at' loW.tid~e~ 'Aver-. ~ise in't~de: DistancetO.._neareSt-~h~n~-~: . ~/~ ~ '.Distance Project .extends.beyond.aimilar projects ii~area:~ Area zoning..: ..i"~.~,~m-~nand area in acres.: Is project, for Private or business use: Intended use of .property: DesCribe known prior operations cOndUcted on premises: Has'any prior'.ticense or permit been issued to' er.ect ~tructures, dredge~ or deposit.fill on said premises: ~ Has any license or permit ever been revoked or suspended by a Governmental Agency: ~..~ Project Description The project description must also include Plans for reclamation of land disturbed during construction of the principle and accessory structures and underground structures. (i.e., pipeline and septic system; make additional attachments if necessary). Authorization (Where the applicant is not the owner) I residing at (Print-owner of subject property) (Mailing address-phone) do hereby authorize to apply for Coastal Ero'sion permit{s) from the Southoi~ Town Trustees Signature THI.S IS NOT A PERMIT Albert $. Kmp.ski, President John Holzapfel, Vice President William G. Albertson Martin I-t. Garrell Peter WenczeI Town Hall 53095 MalnRoad P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-I892 Fax (516) 765~1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD S.E.Q.R.A. NEGATIVE DECLARATION ~OTICE OF NO SIGNIFICANT EFFECT ON THE ENVIRONMENT APPLICATION NO. 1000'-44-1'1.0 NAME: Donald Cavaluzzi DATE: March 31, 1995 Chapt. 97 - Wetlands Chapt. 37 - Coastal Erosion RESOLVED that pursuant to. Article 8 of the Environmental Conservation Law, State"Environmental Quality Review and 6NYCRR Part 617, Section 6T7.10 and Chapter 44 of the Code of the Town of Southotd, notice is hereby given that the Southold Town Trustees, as Lead Agency for the action described below, has determined that the project wilt not have a significant effect on the environment. Please take further notice that this declaration should not be considered a determination made for any other department or agency which may also have an apPlication pending for the same or similar project. TYPE OF ACTION: Type: I DESCRIPTION. OF ACTION: Applicant requests a Wetland Permit to construct 60 1.f. of timber bulkhead with 2 12' returns and place approx. 1.00' c.y. of clean fill, all in accordance with NYSDEC Plans dated 1/5/9'5. LOCATION': SCTM ~'1000-44~1-10 REASONS SUPPORTING THIS DETERMINATION: 1. An on site inspection has been conducted by the Board of Trustees. 2. An environmental assessment, submitted by the applicant and reviewed.and completed by the Board of Trustees,. has indicated that no'significant adverse e~fects to the environment are likely to occur should the project be implemented as planned. cc. CAC New York. S~ate Depart.men~.~of Environ.mental Conservation B.uiiding 40--SUNY, Sro.ny E}rc=l% New York I ~1790-2356 Telephone (516) 444-0365 Facsimile (516) 44.4-0373 Langdon .Marsh Commissioner January 5, 1995 Mr. Donald Cavaluzzi 92.Murray Drive Westbury, NY 11590 RE: 1-4738-00453/00004-0 Dear Permi'ttee: In conformance with the requirements of the State Uniform Procedures:Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing .your permit.. Please read all Conditions 'carefully. If you are Unable to comply wi~h any conditions, please contact '.us at the above address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather. Very truly yours, Margaret M. Rorke EnCon Program Aide MMR:cg enclosure C~ prin~ed on recycled pape~ .! DE~ PERMIT NUMBER 1'-47~8-00~53/0000~ FACILITY/PROGRAM TYPE OF. PER#ET ti geu ~ Rene~a~ ArticLe 1'5, Title 5.. Protection ' PE iT Permit to Constr~ I3 Permit to Operate D of Waters Article 15, Title 15: Water Supply Article 15, Title 15: ~hater Transport Article !5, Title 15: Long Island ge[Es Ar:ic[e 15, Title.27: gild, Scenic and Recreational Rivers Other: PERMIT ISSUED TO Dona[~ :avaLuzzi ADDRESS OF PERHITTEE 92 Hurray Drive ~estbu~y, NY 11590 · 6NYCRR 608: Water gua[ity. Certification B B Article 17, Titles 7, a: SPOES Article 19: Air Pollution Article ~.~, Title 27; #ir~od'Land Eectamatio~ Article 2~: Freshuater ~etlansls Article 25: Tidal Wetlands CONTACT PERSCN FOR PERNITTED WORK Same ~AI,IE AND AODRES$ OF PROJECT/FACILITY Cava[uzz[ Property 55355 ~oute&8 D D D D Article 27, Title 7; 6NYCRR sot i~ ~este Management Article 27. Title 9;-6NYCRR $73: Hazardous~aste ~anageaent Article~:. Coastal Erosien Management Article 36: Ftoocip.tafn Management Articles 1, ~, 17, 19, 27, 6NYCRR Z, SO: Eadi. ation TELEPHONE ~UMBER (516) 334-5950 TELEPHONE flUIE4~ER LOCATION OF PROJECT/'FACZLITY $o[ithotd, .NY 1197~ COUNTY I TOkai I YATERCOURSE I #YTM COORDINATES Suffo[~ Sc, Jtho[d Long Island ~li"'l IC~I CJ:: ~'~,q1"C~lm] ,/~'-TIVITY Construct 60 Linear feet ti~i~er b~lkh.ead. Cor~truct (2) 12' returns. Place approximately 100 cubic yards clean fi[[. ALL uork to be done in accordance uith at~orow~d ~¥SOEC plan~ ay acceptance of this permit, the permittee agrees that the permit is contingent upon strict coaq~Liance with the ECL, ale applicable regulations, the.'General Conditions specified (see page 2) arx~ any Special Conditions included as part of bhis. permit. ' DEpuTY.REG'tONAL PERH]T N)iliNiSTRk-. · ADDRESS · TOR: . George· W. Hamma'rth Bldg. 40, SUNY, R°om 219, Stony Brook, NY 1'1790-2~56 AUTflOR IZED SIGNATURE DATE . I nspe~t i orks 1, The I~rmitted site o.r faoil ity, in, Iud. lng relevant records, is subject to in- spection at reasonable hours and intervals by an authorized representative of the Dapa. r~nent of Envirom~ntai Conservation (the,Departrmnt) to determine v~ether the permittee is ccrrplying with this permit and the EDL. Such represen- tative may order the v~rk suspended pursuant to'ECL 71-0301 .and S~A 401 (3). A copy of this permit, including' all referenced traps, dra~vings and speciaf · condition, s, rr~st be avaii.abie for inspection by the Deparl~ant at all tin~s a.t the project site..Failure to pr. educe a copy of the permit upon request by a Depertrmnt representative is a violation of this pe.rmit. Permit Changes. and 2. The Departrrent reserves the right to rr~ify, suspend or revoke this permit ruben a) the scope .of the permitted ac.tivi~y i.s .exceeded. o.r a violation of any condit'ion .of. the permit or provisions of 'the B:~ and pertinent regula- t i OhS i s found; b) the permit .was obtained by misrepresentation or failure to disclose relevant facts; c) ne~vrra~erial i. nforrration is discovered'; or d) envi.rorrrenta't- conditions, relevant technology, or applicable taN. or regulation have rraterial ly changed since, the permit' v~s issued, 3. The permittee rrust sul~nit a separate written appI'iicati-on to the Departrr~nt for renewal, rrodi'fiCation o.r transfer of this permit. !Such appl ication rrust include any forms, Tees or suppIeT~ntal informat ion the Dapartrr~nt requires. rene¢~t, rr~ification or transfer granted by the Departrrent trust be ~n writing. 4. The .permittee r rus~ sul~nit a renewal application at least: a) 180 days before expiration of permits for State Pollutant Discharge Ei:imination System (Si~ES), H~zardous ~N~ste Manage"rent Facilities (FYIVF), .rrajor Air Poi lution Control (AFC} and Solid V~ste Management Faci t i t i.es (~I~/F); and b) 30 days before expiration of all other pen'nit types. 5. Lhless expressly provided for by the Departrrent, 'issuance of this permit does not rrodi~; supersede or rescind any order or determination perviousty issued by the Department or..any of t]~ terns, conditions or ~equ~re-rents contained in such order or determination. Other.Legal .Cb'l igat i~s of l~n'tittee 6. The permittee has accepted e,'~pressly, by the execration of the application, the full legal responsibi.i ity for all damages, direct or ir~Jirect, of v~hatever nature and by Wicrrever suffered, 'arising out of the project described i.n this permit and has agreed to inda-mify and save harmless the State from suits, actions, da"rages and costs of every na-r~ and description resulting frcrn this proj eot. This permit does not convey to the permit.tee any; :right to trespass upon the lands..or interfere with the riparian rights of others in order 'to perform the permitted vv~rk nor does it authorize' the irrpai.rrr~nt of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. 8. The penmi.ttee is responsible for obtaining any'other permits, approvals, lands, easerr~nts and r'ights-of-v~/ that nay be required for this project. Page 2 of 5 ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 'iS (Title $}, 24, That if future operations by' the State of New York require an terat~on in the position of the'structure.or.work hereto authorized, or fi, ~n the open,on .of the Department. of. Environmental Conse~a6on it shall cause unreasonable obstruction [o the free naw~ation of said wa~ers or f[~d flows or endanger the h~th. safety or we[fare the people o'f the' State. or cause Joss or d~tru ction of the natural ~esources of the S~ate, the owner may be ordered by the Depa~.ment to remove or niter the st~ctural work. obstructions, or hazards caused thereby wJ~out expense to the 5~te. and if. upon the exp~ra{ion.or revocation of this permit, the structure, fi)i. excavation, or other modification of ~he watercourse hereby authorized shall not be com- pleted,' the owners, shall, without, expense to ~h'e State. and ~o such' extent end in such time and manner as the Department o~ Environmental Conse~ation may req~ re, remove ail o.~ any portion of the uncompleted structure or f~Jl and restore to ~ts forme~ condition the navigable and flood capacity of the watercourse, No cJai-m shall be made a~a(nst the State of New York' on account of any such remova.[ or That the Sta~e of New York shah ~n no 'case be I~able for ~ny damage or ~n~uw to the structure or work herein authorized which may ~ caused Dy or result from future operations undertaken ~y the State for the conservatio~ or ~mprovemen~ of nay ~ation, or for other purposes, and no claim or right to compen'sat~on shah accrue.from ~ny such dzma~e. Grantin~ of th s permit does not relieve the applicant o~ the responsi- bility of obta[n)~ any other permission consent or appro~.al the U.S Army Corps of En~meers, U.S. Coast. Guard. New York S~ate Office of General Services or (ocz .~oveFnment wh'ich may be required. Al) necessary preca~t~cns shah be t~ken to preciude contamination of any wedand or waterwav b~ ~spended solids, .sediments. solvents, lubr~c.an~s, eOoxy ccat)~s. ~amts. cbncrete. )eachate o~ any 25, 34 and 6 NYCRR Part 608 ( TIDAL WETLAND ) other enwronmentalIy deleterious mDte~Jals associated with the project, 13 ^ny material dredged in the prosecution of the work herein permitted shat) be remov~ ~enly, without ).ea~ng brge refuse plies, ridges across the bed of a war--ag'or floodplain or deep holes that may have a ~endency to cause damage to navigable cfiannels or to the ban,s'of a wa:e~vay~ g4 There shall be no unreasonable interference wKh navigation by the work herein authorized. 15. If u~n the exoiratiom or revocation of this permit, the grog.ct hereby authoriz~ h~ not b~n comoteted; the apvlican~ shall, without expense to the State. ~nd to ~uch exteat and ~n such time and manner as the Department of Environmental c0nse~ation may require, remove ail or any portion of the uncompleted structure or ill] and restore the site to. its former condition. NO ciaim shat] be made against ~he State of New ~ork on account.of any such removal ot alteration, 16 If granted under 6 NYCRR pa~ ~, the NYS Department of Environ- manta Conse~at~on hereby certifies that the sub'[eot projec~ w[H not contravene eff[uent limitations'or other limitations or standards under Sections 30t, 3027 30~, 306 and 307 of the Clean Water Act of.1977 (PL 95-2t7) provided ~at att of the conditions [[sted herein ~re met 17 All activities.authorized by this permit.must be in strict.conformance with the approved pla~s s~bmitted by.the applicant or his agent as Dart 'o[ the permit appiicaUon. Such app. rov~ plans were prepared by SCamped, ~SDgG a~p~ed on 1/03/95 SPECIALCONDITiONS Any debris or excess material from construction of this project sba1! be completely removed from the adjacent area (upland) and removed to an approved upland area for disposal. No .debriS. is permitted in tidal wetlands and or protected buffer areas. All areas of soil disturbance resulting from this project shall be stabilized immediately following.project completion or prior to permit expiration, whichever comes first. The approved methodologies are as follows: stabilization of the entire disturbed area with appropriate' vegetation (grasses, etc.). c'. Temporarily stabilized with straw or. hay mulch or jute matting or other similar natural fiber matting Within i week of final grading. Temporary stabilization shall be maintained until a mature vegetative, cover is established. 3. Ail fill shall consist of "clean" gravel and soil (not asphalt, slag, flyash, broken concrete or demolition debris). ' No excavation of the beach is authorized for the purpose obtaining fill or stone materials. of DEC PERMIT NId.MBI:R ~ 1-4738-00453/00004-0 , Page 3 of 5 ' 9~QO-6f [7/87)--25c NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS For Article~ !- Tidal Wetland Ail peripheral berms, cofferdams, rock revetments, seawalls, gabions, bulkheads etc.. shall be completed prior to placement of ·any fill material behind such structures. There shall be no discharge of runoff or other· effluent over or through any bulkhead or Shoreline stabilization structure· or into any tidal wetland or adjacent area·. Supplementary Special Conditions (A)·through (F) attached DEC PER,MIT NUMBER t-47'38~00453/00004~0 FACILJT? ID NUMBER P'ROCRAM NUMBER Page 4 Of 5 SUPPLEME~T~RY SPECIAL CO.NDiTIGNS ~he following con~aions appi~ to all Tidal .... .t!ands; Fresh, tot ~e.tlands; Coastal Erosion Hanaq~ent; and Wild, Sc~'ic, ~ Recreational Rivers Pe~its: A copy of this permit, including all conditions and approved plans, shall be available at the project site whenever authorized work is in progress.. The permit sign enclosed with the permit shall be protected from the weat.her and posted in a conspicuous location at the work site until all authorized work has been completed. The permittee shall require that any contractor, project engineer, or other person responsible for the overall supervislon of this project reads, understands, and complies witch this permit and all its general, special, and supplementary special conditions. ~y failure to comply precisely wi~l all of the terms ~nd conditions of this permit, unless authorized in ~uriting, shall be treated as a violation of t/ne Environmental Conservation Law. If any of the permit conditions, are unclear, the pel-mittee~=_~'~]~ contact the Division of Reguiato~--y Affairs at t~ke address on page one or telephone (516) 444-0365. if project design modifications become necessary a~tar pez~mit issuar~ce, t2~e permittee shall submit the appropriate plan changes for approval by the Regional Pe_~mit Administrator prior to undertal<ing any such modifications. The permittee is advised substantial modification may rec~.aire submission of a ne~ application for permit. At least 48 hours prior to cc~=encement of the project, the petit=me and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all te_~ms and conditions of ~his permiu. Within 30 days cf completion of the pe_--mitted work, ~he bottom portion of that form shall also be signed and ret~'~rned, along with photographs of t_he completed work and, if required, a survey~ For projects involving activities to be undertaken in phases over a period of more than one year, the pe~mittee shall notify ~ke .Regional Permit A~inistra~or in ~iting at least 48 hours prior to recommencing work in subse'quen~ years. The granting of this permit does not relieve =he permittee cf the resuonsibiiity cf obtaining a grant, easement, or o~her necessary approval from the Division of Land Utilization, Office of General Se_~vices, Tower Bui!dinq, ~ire State Plaza, Albany., ~ 12242 (5IS) 474-2195, whic~h may be' required for any encrcaclnment upon State-oWned lands DEC Permit No. 1-4738-00453/0000:4-0 Page 5 of 5 i / / / i f I t f County of Suffolk.) State of New York ) . "' B'EING DULY SWORN DEPOSES AND A S~THAT HE/SHE iS THE APPLICANT FOR T~E-ABOvE DESCRIBED PERMIT(S) AND THAT ALD STATEMENTS CONTAINEDiHEREIN ARE TRUE TO THE BEST 'OF HIS/HER K~OWLEDGE AND BELIEF, AND.THAT WORK WILL BE DONE-IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED' BY .THE SOUT~OLD TOWN BOARD OF TRUSTEES.. THE APPLICANT AGREES TO .HOLD THE TOWN OF SOUTHOLD AND'THE TOWN TRUSTEES ,HARMLESS'AND FREE FROM ANY AND ALL DAMAGESAND CLAIMS. ARISING UNDER. OR.BY".VIRTUE OF SAID .PERMIT(S.)~ IF GRANTED. IN COMPLETING'i?'TH1S~APPLICATION.,.t RqERE.BY AUTHORIZE THE TRUSTEES, THEIR 'AGENT(.~.~"OR'~REPRESENTATIVE(s), TO ~ENTER~ONTO MY PROPERTY TO INSPECT THE.~PREMISES tN CONJUNCTION WITHrREVIEW OF THIS APPLICATION. SWORN TO BEFORE ME THIS ~ DAY OF ~/~/~J ,1993 Suggested space for location Map THIS IS NOT A PERMIT ':"" ' l"~"~6'4'12/8~-Te×t 12 ' ~" ~"""~QJECT LD. NUMBER 6 ~ 7.2'~ S EQ [ Appendix C State Environmental Quality Review ? SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I~PROJ. ECT INFORMATION (To be completed by ApDlicant or P~oject Sponsor) 1. APPLICANT/SPONSOR.~~.__..~~,~,,~. "'~'"~"~.L~' 3..PROJECT LOCATION:. Munictoallty Coumy 4; PRECISE LOCATION CStreet aaaress and road intersections, prominent ~an~marks, etc., Or prOw~emap) 5. IS' PROPOSED ACTION: [] New [] Expansion 0dification/alteration 6. DESCR BE.PROJECT BRIEFLY: ' - ' ' 7. AMOUNT OF LANEJ AFFECTED: tnitiarry ~ acres Ultimately WILL PROPOSED ACTION COMPLY. W~TH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? [] NO If No, describe briefly WHAT IS PRESENT LAN,D USE N VICINITY OF PROJECT? ~esJdentiai [] !ndustri,31 [] Commercial ~ AgricuJture Oesc~be: [] ParklForestlOpen =pace [] Other 10, DOES ACTION INVOLVE A PERi, IT APPROVAL, OR FUNDING, NOW OR'ULTiMATELY FROM ANy OTHER GOVERNMENTAL AGENCY (FEDERAL, Il. STATE OR LOCAL)? ~.Yes [] No If ye~, list agency(s) and permJtla~provals DOES ANy ASPECT OF THE ACTIOr~ HAVE A CURRENTLY VALID PER~IT O,q APPROVAL? []t/O i! ye~., I/st agency name and permit/approval 1~. AS[] AyesRESULT~OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODiFiCATiON CERTIFY THAT tg4E~tN!FORMATiON PROVIDED ABOVE IS TnUE TO THE BEST OF MY KNOWL. EDGE / .' / ..... D Ia: he action is in the ! Area, and you are a state agency, complete the Coastal Assessment Form before proceeding wilh this assessment 'OVER 1 IOi~-EXCEED ,ANY 'rv~ ,~-~._" ' '. ....... ...~. · . · - . . ~1 -"'~.. . W~LL AG~ON RECE]V~ COOROrNATED R~I~ AS PROVIDED FOR UNM$~ACT~ONs ['N 6 NYCRR., PAR~ 6~7~..a negative ~eclata*jo~~ may be SUperseded by aoothe'r invotve~ a~ency. ' C.. COULD ACTION RESULT IN ANy A~VERsE EFFECTS A'SSoCIATED W C1. Ex!shng air q~alit~ s~rtace ~ ......... TH THE FOLLO ~ ...... ' Potential for ~-~' ' ~ ~ ~' u,~cwa~er quai~ or ~.~n~iw, ~1,.~, ~wers may bo h~.,~ '~ .... ~on, uramage or floO~ing problem.~ .... 7~-,~,~.~.. nome levels, ex~sting {raUic patze'ms .A~:';'~"'~n' =t Ioq~e) -- ~-~p~am or~e/ly: . , ~,,~ waste Pro~uctj~ or ~lspOsa~ C2. Aesthetic, agticurtural, archaeological, hrstc~ric, or other natural or cul,tura! resources; or corn mumty or neighboi-hood Character?. Expi'air~ brtefly: C~ Vegetatiorl Or fauna, fi=h, 'S~leUffsh or WiidE.fe sDecies, significant habilats, or t,~reatened or endangereO s~3ecies? Explain Orderly:.. C~. A community's exi.$t'i.ng' P~an's or goals as officially ado~3tecL or.a C~ange .in use' or intensity et use of land-or other natural resources? Ex glalri" ~3r~e fly i C~;. Gtowlh,. ..SubseqUent..'--.- .'---- develooment,.....,..., or relate~ aclwi~ie$ likely'to be mcluced by tt~e ProDoseel action*, E.'(olatrt One~ly. C~;. Long term, snort term, cumulative, or other effects not identitied in C1-C57 Explain ~3rielly, C7. Oft:er impacts lJnCl~d~ng changes_ .in use of either quantity or type et energy)? Exl3Jam Drmfly. · rD ^ov s,E Yes ~ No If Yes, explfiin b~ie[ly PART [Ii--'DETER'MINA.?iON OF SIGNIFICANCE (To be completed b'y Agency) ---__ INSTRUCTtO.NS: For each adverse e.~fect identitied above, determine Whether it is substantial, large, important or Oth~vise significant. Each eltect should be assessed.in Connection with its la} se/ting (f.e. urban or rural); lb} probability et Occurr[n.g; (c) duration; itr~vers~b.ilily; (e) geographiC, scc pr; and (0 magnitude, l't necessa~, add attachmenls or reference supporting materials. ~suro that exP~anal~on.s contain su¢ficJent detail to show that aU re~evant adverse impacts have been identified and adequ.ate[y addressed. ~heckth?.~ ,. ' .' · . ' ' ...~°x ,'youhav:'. ..: 'ldenhhed one or moro pot~tl~ljy large or significant aov, , - . ~'..~ ~ Check thru box if you have determined, based o.~°the information and ers - [)ale -' - - 2 ~ iP~RA4[T ~nviroame. nta[ Con'~ervation Law (ECL) ,, -.., :- ./pp3 '.. .. " ~ P~t to Construct ~ Permit to OD~te A~cle'.27, ~tle'~9; 6NYCRR 373: H~rdous Waste Management Article'~i5, Title 5i · ~ Article 17, Tittes 7. 8: Pratection of Water . SPOES -- ArtJcie .15. Title 15: __ Water':Supply Article.~.iS. Titte 15: · . Watec..Tmnspart A~cJe:.~lS, Titte 15: Long Island Wells Article .15, Titie 27' Wild. Scenic and R~creational Rivers.:.: 6NYCRR 608: Water ~uality Certification Article 19: Air PollutJan Control Articie 23, Title 27: - Mined Land Reciamatio~ Article 24: Freshwater Wettands Article 25: Tidal Wetlands Article 27, Titie 7: 6NYCRR 360: Solid' Waste Management Article 34: C0as~ '~-osian Management Article 38: FlOOdplain 'Management Articles 1, 3, 17, t9,. 27, 37; 6N¥CRR 3S0: Radiation Controt 0that: t TELEPHQNE NUMBER I,L.? I j TELEPHONE NUMBER ,~IAME ANO AODRES$~,~ PROJECT]FACiLITY LOC^T[ON OF PROJEC~C!LITY COUNTY ~ '".... j TOSYNiC.4~t:~=%G~-~- j WATERCOURSEfWETLANO NO. . NYTM COORDINATES OESCRIPTION OF AUTHORIZED ACTIVITY Place approx;m~tely [~0 cubic yards of up.l~d fill to restore eroded sections of ~ By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECl_, alt applicable regulations, the General Conditions specified (See Reveme Side).'and any Special Conditions .included as part of this permit. ~ ~--; ~-~, ~ 1 , , , . .... '~~ST~TO~ ~OO~SS Regul'aCory Affairs, Regzon. ~e - Bldg. 40 [R~bert A~' Gr'e~. ,,. ~ . I' . Stony BrOok' ~ 11790'2356